Customer Service Medicare Part

Mandi Crew

Topeka, KS

***********@*****.*** 785-***-****

Summary

Enthusiastic healthcare professional with 5 years of experience seeking a role in a Remote position. Skilled in case processing, eligibility assessments, and delivering exceptional customer service in healthcare settings. Proficient in remote communication, documentation, and upholding regulatory compliance. Experience

Medicare Part D Prior Authorizations and Appeals Representative Integrated Resources

Nov 2023 - Apr 2024 (6 months)

• Conducted comprehensive case reviews for Medicare Part D appeals, ensuring adherence to regulatory turnaround times and quality benchmarks.

• Upheld elevated expectations of productivity, consistently meeting or surpassing departmental objectives for case processing.

• Maintained currency with evolving Medicare Part D regulations to accurately process prior authorizations and appeals.

Member Service Representative

Broad Path Healthcare Solutions

Nov 2021 - Feb 2023 (1 year 4 months)

• Addressed and resolved member inquiries by providing detailed explanations of health plan benefits, coverage, and eligibility, ensuring accurate and efficient information dissemination.

• Employed advanced systems and databases to accelerate problem-solving and information retrieval, meticulously documenting all interactions for quality assurance and trend analysis.

• Provided exemplary customer service, characterized by patience, empathy, and active listening, cultivating positive relationships, and skillfully managing complex customer situations. Eligibility Specialist

Manpower Group

Sep 2019 - Jan 2020 (5 months)

• Executed in-depth evaluations of Medicaid applications, scrutinizing essential factors such as household composition, financial status, and expenditures to ascertain eligibility accurately.

• Rendered precise eligibility verdicts and effectively communicated outcomes to applicants, utilizing formal written notifications to simplify complex information.

• Orchestrated ongoing client interactions, soliciting required documentation and updating case developments, while rigorously recording all communications in the designated database system. Patient Care Coordinator

Integrated Sleep Resources

Feb 2018 - Dec 2018 (11 months)

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• Collaborated with patients, physicians, and staff to conduct a comprehensive analysis of medical charts, enhancing open communication and teamwork.

• Demonstrated proficiency in accurately inputting patient insurance, demographic, and health information into software, ensuring record completeness.

• Proactively communicated with medical providers to ensure prompt resolution of inquiries and concerns, following up on requests as needed.

• Ensured efficiency and precision in processing distinct documentation, facilitating seamless workflows.

• Adhered strictly to HIPPA standards and organizational protocols, protecting the confidentiality and security of patient records during data transfers. Program Coordinator

Preferred Family Healthcare

Jan 2017 - Dec 2017 (1 year)

• Orchestrated comprehensive training sessions to enhance staff members' knowledge of clients' medical needs, preferences, and care plans, fostering a supportive and informed environment.

• Ensured staff remained vigilant of clients' medication protocols and potential side effects, facilitating timely updates and changes to maintain optimal client care.

• Oversaw and audited daily residential notes, goal progress, health tracking, and Medication Administration Records (MARS) for precision, securing necessary approvals to uphold care standards.

• Streamlined staff scheduling processes and coordinated coverage for absent personnel, guaranteeing the continuity of client care services.

Direct Support Staff

Preferred Family Healthcare

Oct 2016 - Jan 2017 (4 months)

• Coordinated client engagement in diverse activities, including medical appointments, recreational outings, and community events, by providing essential transportation and personal assistance.

• Administered medication in strict adherence to prescription schedules, maintaining meticulous records to ensure error-free documentation.

Education

Vatterott College

Diploma, Medical Office Assistant

2005 - Present

Skills

HIPPA • Customer Support • Time-Management • Multitasking • Adaptability • Detail Orientated • Phone Etiquette • Teamwork • Empathy

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